HomeMy WebLinkAboutDURAN EXCAVATING INC. - INSURANCE CERTIFICATEClinnf$• 9A41 �.
ACORDTM CERTIFICATE OF LIABILITY INSURANCE
DATE
12/14/2009rvr)
PRODUCER
Flood & Peterson Ins. Inc.
P. O. BOX 578
4687 W. 18th Street
Greeley, CO 80632
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Duran Excavating Inc
418 N 9th Ave
Greeley, CO 80631-2350
INSURER A: Travelers Insurance Company
INSURER B: Pinnacol Assurance
INSURER C:
INSURER D:
INSURER E:
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THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
EFFE
D TE (MM/DDNYE
POLICY) DATE MM DDTION
LIMITS
A
GENERAL LIABILITY
DTC08077BO49IND09
04/09/09
04/09/10
EACH OCCURRENCE
$j 00Q 000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$300 000
CLAIMS MADE F_x1 OCCUR
MED EXP (Any one person)
$1 O 000
PERSONAL & ADV INJURY
$1 000 000
X PD Ded:2,500
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
s2,000,000
POLICY PRO LOC
JECT
A
AUTOMOBILE LIABILITY
X ANY AUTO
DT8108077BO49TIL09
04/09/09
04/09/10
COMBINED SINGLE LIMIT
(Ea accident)
$1 ,000,000
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
X HIRED AUTOS -
X NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
A
EXCESS/UMBRELLA LIABILITY
DTSMCUP8077BO49TIL
04/09/09
04/09/10
EACH OCCURRENCE
s5,000,000
X OCCUR CLAIMS MADE
AGGREGATE
$5 000 000
$
DEDUCTIBLE
$
X RETENTION $ 10000
B
WORKERS COMPENSATION AND
4110254
01/01/10
01/01/11
X I TORYWC STLIMITS ATUS CETR
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$1 OOO 000
E.L. DISEASE - EA EMPLOYEEI
$1 000 000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1 OOO 000
A
OTHER Equipment
OT6601423C736TIL09
04/09/09
04/09/10
Blanket Limit
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Project: Construction of the 7048 Mason Bike/Pedestrian Trail - Spring Creek to Prospect Road
City of Fort Collins and CDOT are named as Additional Insured.
City of Fort Collins
Purchasing Division
215 N. Mason Street 2nd Floor
P. 0. Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL A0_ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #S494076/M494063 DSM 0 ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-5 (2001/08) 2 of 2 #S494076/M494063